Published online before print June 21, 2004, doi: 10.1161/01.CIR.0000134481.24511.BC
(Circulation. 2004;110:124-127.)
© 2004 American Heart Association, Inc.
Original Articles |
Plasma B-Type Natriuretic Peptide Levels Predict Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery
From the Center for Atrial Fibrillation, The Cleveland Clinic Foundation, Cleveland, Ohio.
Correspondence to Andrea Natale, MD, Co-Head, Section of Pacing and Electrophysiology, Director Electrophysiology Laboratory, Co-Director Center for Atrial Fibrillation, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Desk F 15, 9500 Euclid Ave, Cleveland, OH 44195. E-mail natale{at}ccf.org
Received December 29, 2003; revision received March 16, 2004; accepted March 22, 2004.
Background— Postoperative (postop) atrial fibrillation (AF) occurs in up to 60% of patients after cardiac surgery, leading to longer hospital stays and increased healthcare costs. Recently, B-type natriuretic peptide (BNP) has been reported to predict occurrence of nonpostoperative AF. This study evaluates whether elevated preoperative (preop) plasma BNP levels predict the occurrence of postop AF.
Methods and Results— One hundred eighty-seven patients with no history of atrial arrhythmia who had a preoperative BNP level and had undergone cardiac surgery were identified. Their records were reviewed, and postoperative ECG and telemetry strips were analyzed for AF until the time of discharge. Postop AF was documented in 80 patients (42.8%). AF patients were older (68±11 versus 64±14 years, P=0.04), but there was no difference in sex distribution, hypertension, left ventricular (LV) function, LV hypertrophy (LVH), left atrial size, history of coronary artery disease (CAD), or ß-blocker use. Preop plasma BNP levels were higher in the postop AF patients (615 versus 444 pg/mL, P=0.005). After adjustment for age, sex, type of surgery, hypertension, LV function, LVH, left atrial size, CAD, and ß-blocker use, the odds ratios of postop AF according to increasing quartiles, compared with patients with lowest quartile, were 1.8, 2.5, and 3.7 (Ptrend=0.03).
Conclusions— An elevated preop plasma BNP level is a strong and independent predictor of postop AF. This finding has important implications for identifying patients at higher risk of postop AF who could be considered for prophylactic antiarrhythmic or ß-blocker therapy.
Key Words: atrial fibrillation • peptides • cardiac surgery
This article has been cited by other articles:
 |
|
 |
|
  G. Sodeck, H. Domanovits, M. Schillinger, K. Janata, M. Thalmann, M. P. Ehrlich, G. Endler, and A. Laggner Pre-operative N-terminal pro-brain natriuretic peptide predicts outcome in type A aortic dissection. J. Am. Coll. Cardiol., March 18, 2008; 51(11): 1092 - 1097. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Casaclang-Verzosa, B. J. Gersh, and T. S.M. Tsang Structural and functional remodeling of the left atrium: clinical and therapeutic implications for atrial fibrillation. J. Am. Coll. Cardiol., January 1, 2008; 51(1): 1 - 11. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. B. Daniels and A. S. Maisel Natriuretic Peptides J. Am. Coll. Cardiol., December 18, 2007; 50(25): 2357 - 2368. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 NACB WRITING GROUP MEMBERS, A. H.B. Wu, A. S. Jaffe, F. S. Apple, R. L. Jesse, G. L. Francis, D. A. Morrow, L. K. Newby, J. Ravkilde, W.H. W. Tang, et al. National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Use of Cardiac Troponin and B-Type Natriuretic Peptide or N-Terminal proB-Type Natriuretic Peptide for Etiologies Other than Acute Coronary Syndromes and Heart Failure Clin. Chem., December 1, 2007; 53(12): 2086 - 2096. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. W. Sear and G. Howard-Alpe Preoperative plasma BNP concentrations: do they improve our care of high-risk non-cardiac surgical patients? Br. J. Anaesth., August 1, 2007; 99(2): 151 - 154. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Cannesson, C. Bionda, B. Gostoli, O. Raisky, S. di Filippo, D. Bompard, C. Vedrinne, R. Rousson, J. Ninet, J. Neidecker, et al. Time Course and Prognostic Value of Plasma B-type Natriuretic Peptide Concentration in Neonates Undergoing the Arterial Switch Operation Anesth. Analg., May 1, 2007; 104(5): 1059 - 1065. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Cardinale, A. Colombo, M. T. Sandri, G. Lamantia, N. Colombo, M. Civelli, M. Salvatici, G. Veronesi, F. Veglia, C. Fiorentini, et al. Increased Perioperative N-Terminal Pro-B-Type Natriuretic Peptide Levels Predict Atrial Fibrillation After Thoracic Surgery for Lung Cancer Circulation, March 20, 2007; 115(11): 1339 - 1344. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Osranek, K. Fatema, F. Qaddoura, A. Al-Saileek, M. E. Barnes, K. R. Bailey, B. J. Gersh, T. S.M. Tsang, K. J. Zehr, and J. B. Seward Left Atrial Volume Predicts the Risk of Atrial Fibrillation After Cardiac Surgery: A Prospective Study J. Am. Coll. Cardiol., August 15, 2006; 48(4): 779 - 786. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
U. C. Hoppe, J. M. Casares, H. Eiskjaer, A. Hagemann, J. G.F. Cleland, N. Freemantle, and E. Erdmann Effect of Cardiac Resynchronization on the Incidence of Atrial Fibrillation in Patients With Severe Heart Failure Circulation, July 4, 2006; 114(1): 18 - 25. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Cosgrave, J. B. Foley, E. McGovern, K. Bennett, V. Young, M. Tolan, P. Crean, and M. Walsh Brain natriuretic peptide elevation and the development of atrial fibrillation following coronary artery bypass surgery Interactive CardioVascular and Thoracic Surgery, April 1, 2006; 5(2): 111 - 114. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. R. Potter, S. Abbey-Hosch, and D. M. Dickey Natriuretic Peptides, Their Receptors, and Cyclic Guanosine Monophosphate-Dependent Signaling Functions Endocr. Rev., February 1, 2006; 27(1): 47 - 72. [Abstract] [Full Text] [PDF]
|
|